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    Participant Questionnaire? Risk Warning? Liability Waiver / Release? and Indemnification Document. I understand the risks, hazards, and dangers that may be encountered over the two day course and have had the opportunity to discuss them with the instructor. I am not under the influence of alcohol or drugs. My participation in this clinic is purely voluntary. No one is forcing me to participate and I elect to Do so.

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    Participant Questionnaire? Risk Warning? Liability Waiver / Release? and Indemnification Document. I understand the risks, hazards, and dangers that may be encountered over the two day course and have had the opportunity to discuss them with the instructor. I am not under the influence of alcohol or drugs. My participation in this clinic is purely voluntary. No one is forcing me to participate and I elect to Do so.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    70 views3 pages

    Releaseform

    Uploaded by

    api-318170149
    Participant Questionnaire? Risk Warning? Liability Waiver / Release? and Indemnification Document. I understand the risks, hazards, and dangers that may be encountered over the two day course and have had the opportunity to discuss them with the instructor. I am not under the influence of alcohol or drugs. My participation in this clinic is purely voluntary. No one is forcing me to participate and I elect to Do so.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    ParticipantQuestionnaireRiskWarningLiability

    Waiver/ReleaseandIndemnificationDocument.

    1)
    PARTICIPANTQUESTIONNAIRE:
    a.Name:______________________________________________________________
    b.Address:____________________________________________________________
    c.PhoneNumber:_________________________________________Age:__________
    d.EmergencyContact:___________________________________________________
    e.Relationshiptoyou:___________________________________________________
    f.Doyouhaveanymedical,physical,oremotionalconditionthatwould
    beadverselyaffectedbythisactivity?______________________________________

    PleaseDescribeifso:_________________________________________________
    __________________________________________________________________
    Areyoupregnant?___________

    2)

    RISKWARNING,WAIVERANDRELEASEAGREEMENT
    Pleasereadcarefullybeforesigning.
    THISISARELEASEOFLIABILITYANDWAIVEROFCERTAINLEGALRIGHTS
    Inconsideringformybeingpermittedtoparticipateintheactivitiesof
    TrailRiding
    ClinicwithMariahMalcolm
    andtheuseofmyproperty,animals,ifany,andfacilities,Iagree
    tothefollowing:

    I_________________________________________________________acknowlegdethat
    thereareinherentrisks,hazardsanddangers,that
    cannot
    beeliminated.IUNDERSTAND
    THATTHESERISKS,HAZARDS,ANDDANGERSINCLUDEWITHOUTLIMITATION.
    Iunderstandtherisks,hazards,anddangersthatmaybeencounteredoverthetwodaycourseand
    havehadtheopportunitytodiscussthemwiththeinstructor.Iunderstandthattheseactivities
    mayrequiregoodphysicalhealthandadegreeofskillsetandknowledge.IbelieveIhavethat
    goodphysicalconditioningandskillsetandknowledgenecessaryformetoengageinthose
    activitiessafely.IunderstandthatIhaveresponsibilities.
    IWILLPAYSTRICT
    ATTENTIONTOTHEINSTRUCTIONANDSAFETYLECTUREANDIWILL
    COMPLYWITHTHEDIRECTIONOFTHEINSTRUCTORANDHIREDHAND(S).
    I
    amnotundertheinfluenceofalcoholordrugs.Myparticipationinthisclinicispurely
    voluntary.NooneisforcingmetoparticipateandIelecttoparticipateinspiteoftherisks.I
    AMVOLUNTARILYUSINGTHESERVICESOF
    MARIAHMALCOLM
    WITHFULL
    KNOWLEDGEOFTHEINHERENTRISKS,HAZARDS,ANDDANGERSINVOLVED

    ANDHEREBYASSUMEANDACCEPTANYANDALLRISKSOFINJURY,PARALYSIS,
    ORDEATH.

    WARNING
    UNDERMONTANALAW,ANEQUINEPROFESSIONALISNOTLIABLEFOR
    DAMAGESSUSTAINEDIFTHOSERISKSAREORSHOULDBEREASONABLY
    OBVIOUS,EXPECTED,ORNECESSARYTOPERSONSENGAGEDINEQUINE
    ACTIVITIES,PURSUANTTOSECTION271725

    IHAVEREADTHISDOCUMENT.IUNDERSTANDITISARELEASEOFALL
    CLAIMS.IUNDERSTANDTHATIASSUMEALLRISKINHERENTINACTIVITIES
    WITHHORSES.IVOLUNTARILYSIGNMYNAMEEVIDENCINGACCEPTANCEOF
    THEABOVEPROVISIONS.
    SignatureofApplicant(Releasor)_____________________________________________
    GuardianforMinor____________________________________________________________
    Date______________

    Notice:
    Yourhorsemustbewormedpriortoarrivingattheproperty.Proofofcurrent
    vaccinationsandhealthrecordandNegativeCogginstestmustbesentaheadofarrivingorbein
    handbeforeunloading.Horsesmustbevaccinatedwiththefollowing
    (Atleast3weeksin
    advance):

    E.W.Encephalomyelitis

    EquineViralRhinopneumonitis

    EquineInfluenza

    WestNileVirus

    Tetanus

    Strangles

    All
    participantsrequiredtocompletewaiveruponregistration.Guardiansmustsignfor
    participantsunder18yearsofage.Pleasenotifyusifguardianwillnotattendclinicandwewill
    mailawaiverform.Minorwillnotbeallowedtoparticipateifwaiverisnotsignedbyguardian
    beforeclassstarts.

    BoardingFees:

    IndividualStallsare$15.00forthefirstnight(includesfirstbedding),$10.00each
    additionalnight/day.doesnotincludehay.Additionalshavingsareavailablefor$7.00
    abag.
    [TomakearrangementsforboardingtopaycallMariah@(406)223333]

    Forinformativepurposesonly,pleasecall4062233331oremail
    oneplainmlm@yahoo.com
    foranactualregistrationform.Alsopleasenotethatspectators
    arenotrequiredtoregisterinadvancetheycanpayatthegateonthedayoftheclinic.

    RETURNREGISTRATIONSHEETWITHDEPOSITTO:
    MariahMalcolm
    818Hwy10West
    Livingston,MT59047

    PLEASEMAKECHECKSPAYABLETO MariahMalcolmInc,

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